Angioplasty and Stents Inappropriate Only 4%
of the TimeA
major study
of a half-million angioplasties, published today1 in
the Journal
of the American Medical Association (JAMA), refutes
two major myths about angioplasty and stent use in the United States:
myth #1, that angioplasty is vastly overused and unnecessary in
most cases; and myth #2, that most angioplasty is used in stable
patients and therefore has little or no benefit over drugs in reducing
death or heart attacks.

Titled "Appropriateness of Percutaneous
Coronary Intervention", this paper is the first comprehensive
look at how closely interventional cardiologists in the
U.S. are
adhering to the practice guidelines for PCI (angioplasty and
stenting) most recently published by the professional cardiology
and surgical
societies
in January 2009.

So...cut to the results! Of the 500,154 procedures
studied, only 20,731 (4.1%) were deemed "inappropriate". And
more than two-thirds of the procedures were
done in patients who were having a heart attack or who were unstable
and at an extremely high risk for having an acute event.

"Great work,"
Dr. Ralph Brindis, immediate past-President of the American College
of Cardiology, told me. He continued:

"What's so fascinating about this
study is the good news: that in general we're pretty
appropriate.
An important point is that 71% of all angioplasty
is performed for either STEMI, NSTEMI or for acute coronary
syndrome (ACS) or unstable angina.... So this is actually in
contradistinction from the first page of the COURAGE Trial
in the New England
Journal which implied that maybe 70% or more of angioplasty
is for stable angina in the United States...and that simply
is not true! Well over 70% of all angioplasty in the United
States is for acute syndromes.

Actually Dr. Brindis was being generous. The COURAGE
Trial put the prevalence of angioplasty in stable patients at 85% when
it is actually at 29% -- the exact opposite!

So,
who cares? What does this matter to patients? Isn't this just another
internal dispute in the medical community? Actually, not! The take-home
message from this study is of vast importance to patients. Angioplasty,
when performed during an acute episode (71% of the time) can save
your life. If you think you are having a heart attack, get to a hospital
that performs angioplasty ASAP. Angioplasty can stop a heart attack
in its tracks!

Angioplasty.Org will be reporting in more detail about
this study, and will also be posting exclusive interviews with Dr.
Paul Chan, lead author of the JAMA
study, Dr. Ralph Brindis, immediate past-President of the ACC and
guiding light for the NCDR registry, and Dr. Gregory Dehmer, former
President of the SCAI and co-author of the Appropriateness Criteria.

But take the following incorrect and distorted "dreadlines"
from today's news with a grain of salt -- unless, of course, you
have high blood pressure: